| NPI | 1164581682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M2768) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 40217) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2019-08-23 |